Breathing During Sleep Immediately after Uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty (UPPP) has been acclaimed in the treatment of obstructive sleep apnea (OSA). Evaluation of the effect of UPPP has usually been done 6 to 8 weeks postoperatively. Recently, a patient died suddenly at home of unknown causes 48 hours following UPPP. Autopsy evaluation demonstrated no evidence of hemorrhage, aspiration, or airway edema; however, it caused us to reassess our postoperative program. Three obese patients (192%, 162% and 157% of ideal body weight) with OSA underwent polysomnography on the second postoperative night. The mean duration of the postoperative apneas was not significantly different; however, the nadir SaO2 during apnea in one patient was significantly lower postoperatively. Those individuals with awake hypercapnia nad hypoxemia who had significant sleep associated hemoglobin unsaturation preoperatively may be at greatest risk. These observations indicate that careful postoperative monitoring is warranted in this group of patients.